比较退伍军人与非退伍军人终末期肾病患者接受血液透析的营养状况和膳食记录
背景：美国退伍军人慢性疾病和社交缺陷（social disadvantage）的发生率高，这些都是蛋白质-能量消耗（PEW）的危险因素。尚不清楚这是否导致患终末期肾病退伍军人PEW发生率高。
方法：我们比较了德克萨斯州中南部接受维持性血液透析（MHD）临床稳定患者的临床、社会经济、营养状况和膳食，其中退伍军人33例、非退伍军人38例。
结果：整个研究队列的82%为墨西哥裔美国人（MA）、72%为2型糖尿病、73%为男性。体重指数为28.9±6.2，能量摄入为21.5±8.2kcal/kg/d，蛋白质摄入为1.0±0.4g/kg/d。血清白蛋白（溴甲酚紫法）为3.5±0.4g/dL，转铁蛋白为171.9±27.8mg/d，C反应蛋白为2.9（1.4～6.5）mg/L，白介素-6（IL-6）为8.3（4.2～17.9）pg/mL，中性粒细胞明胶酶相关脂质运载蛋白为729（552～1256）ng/mL，营养不良-炎症评分为8.8±3.0。调整性别和种族后组间比较，与非退伍军人相比，退伍军人的家庭收入较高、MA较少（60%比100%）、男性较多（94%比55%）、肾素-血管紧张素-醛固酮系统阻滞剂使用较多、血清IL-6水平较低（4.4【3.1～5.8】比15.4【8.3～20.5】pg/mL；P=0.01）。回归分析结果显示，退伍军人血清IL-6水平较低，与透析医院水平、性别独立相关，与家庭收入可能相关。
结论：在这个临床稳定MHD患者的相对小型队列研究中，与非退伍军人相比，退伍军人的营养状况和膳食摄入量相等、炎症较少，因此不支持退伍军人MHD患者的营养状况比配对非退伍军人差的可能性。
Nutr Clin Pract. 2015;30(5):698-708.
Comparison of Nutrition Profile and Diet Record Between Veteran and Nonveteran End-Stage Renal Disease Patients Receiving Hemodialysis in Veterans Affairs and Community Clinics in Metropolitan South-Central Texas.
Cunningham SE, Verkaik D, Gross G, Khazim K, Hirachan P, Agarwal G, Lorenzo C, Matteucci E, Bansal S, Fanti P.
University of Texas Health Science Center San Antonio, San Antonio, Texas.
Audie L. Murphy Veterans Memorial Hospital, South Texas Veterans Health Care System, San Antonio, Texas.
Western Galilee Hospital, Nahariya, Israel.
University of Pisa, Italy.
BACKGROUND: U.S. military veterans have high rates of chronic disease and social disadvantage, which are risk factors for protein-energy wasting (PEW). It is not known whether this translates into high prevalence of PEW in veterans with end-stage renal disease.
METHODS: We compared the clinical, socioeconomic, and nutrition status and the diet of 33 veteran and 38 nonveteran clinically stable patients receiving maintenance hemodialysis (MHD) in south-central Texas.
RESULTS: The whole cohort included 82% Mexican Americans (MAs), 72% type 2 diabetics, and 73% males. The body mass index was 28.9 ± 6.2, while energy intake was 21.5 ± 8.2 kcal/kg/d and protein intake was 1.0 ± 0.4 g/kg/d. Serum albumin (bromocresol purple) was 3.5 ± 0.4 g/dL, transferrin was 171.9 ± 27.8 mg/d, C-reactive protein was 2.9 (1.4-6.5) mg/L, interleukin-6 (IL-6) was 8.3 (4.2-17.9) pg/mL, neutrophil gelatinase-associated lipocalin was 729 (552-1256) ng/mL, and the malnutrition-inflammation score was 8.8 ± 3.0. In group comparison that adjusted for sex and ethnicity, the veterans had better household income, less MAs (60% vs 100%), more males (94% vs 55%), more use of a renin-angiotensin-aldosterone system blockade (66% vs 33%), and lower IL-6 levels (4.4 [3.1-5.8] vs 15.4 [8.3-20.5] pg/mL; P = .01) than nonveterans. In regression analysis, the lower serum IL-6 level in veterans was independently explained by dialysis clinic, sex, and, possibly, household income (intermediate significance).
CONCLUSION: In a relatively small cohort of clinically stable MHD patients, the veterans showed equivalent nutrition status and dietary intake and less inflammation than the nonveterans, thus not supporting the possibility that veteran MHD patients may have worse nutrition than the nonveteran counterpart.
KEYWORDS: diabetes mellitus; ethnic groups; healthcare disparities; inflammation; socioeconomic factors; wasting syndrome
PMID: 25899538
DOI: 10.1177/0884533615575046